The effect of education on patients' willingness to participate in a telemedicine study.

We assessed the effect of previous education on patients' willingness to participate in a clinical study of telemedicine for hypertensive patients. The design was a cross-sectional study of adult patients arriving for appointments in a hypertension clinic. Of the 259 patients approached, 86% completed a baseline survey and were subsequently asked if they would be willing to participate in a one-year telemedicine study. One hundred and fifty patients (58%) agreed to participate. A stepwise logistic regression analysis was performed to assess the effect of level of education on willingness to participate, while controlling for potentially confounding variables. In the final model, only education remained significant. The odds ratio for non-participation of patients with high-school education or less was 3.6 (95% confidence interval 1.9-7.0). Educational status should be carefully considered when designing, implementing and interpreting telemedicine studies.

Patient and physician satisfaction in a clinical study of telemedicine in a hypertensive patient population.

We studied patient and physician satisfaction with telemedicine for the care of a hypertensive population. Once recruited, participants were seen both in person and via telemedicine (in random order) on the same day. After each meeting, patient and physician satisfaction surveys were completed. In the 12-month study, there were 107 pairs of visits. The physicians reported a small but significant increase in workload, mental effort, technical skills and visit duration for telemedicine when compared with face-to-face consultations. They noted that the telemedicine system worked well in the majority of cases and could reduce the need for future treatment. Patients reported slightly but significantly higher satisfaction scores for the following for in-person than for telemedicine meetings: technical quality, interpersonal care and time spent. Patients reported high satisfaction scores for both telemedicine and in-person visits.

Cutting edge: sustained expansion of CD8+ T cells requires CD154 expression by Th cells in acute graft versus host disease.

Brief treatment with alphaCD154 Ab has been shown to prevent acute graft versus host disease (aGvHD). We extend these data to show that in the absence of CD154 function, donor T cells are unable to expand or generate high level anti-host CTL activity. Using transgenic (Tg) alloreactive CD8+ T cells adoptively transferred into allogeneic recipients, we show that short-term expansion of the CD8+ Tg T cells occurred in the absence of Th cells, and this short-term expansion could be facilitated with an agonistic alphaCD40. While CD40 agonism could enhance short-term expansion, sustained expansion of CD8+ Tg T cells required bona fide CD154-expressing CD4+ alloreactive Th cells. While CD154 was necessary for CD8+ Tg T cell sustained expansion, IL-2 was also implicated as essential. These observations suggest alphaCD154 therapy in GvHD is effective because the treatment causes an abortive CD8 alloresponse leading to the exhaustion or deletion of alloreactive CD8+ clones preventing the development of disease.

Difficulties with portable suction equipment used for prehospital advanced airway procedures.

INTRODUCTION: Airway management is the highest priority for prehospital personnel. While different modalities for airway management are under investigation, endotracheal intubation remains the standard for definitive airway protection. Currently, airway adjuncts such as portable suction remain relatively unstudied. OBJECTIVE: To identify utilization and complications associated with portable suction equipment used by prehospital medical personnel. METHODS: Fifty-one paramedics serving a Level I urban trauma center were anonymously surveyed to determine types of equipment used, maintenance and utilization patterns, difficulties encountered, and training received with that equipment. RESULTS: The paramedics reported carrying suction equipment to the scene of medical aid calls less than 25% of the time. Once on scene, suction equipment is utilized during 50% of advanced airway procedures. Half of the paramedics reported complications affecting patient care at least once during their careers due to equipment malfunction. Ninety-eight percent of the paramedics reported having some type of training with the suction equipment for prehospital advanced airway procedures. CONCLUSIONS: The results of this study suggest that suction equipment is carried to the scene infrequently and, when employed, is often found to be functioning suboptimally. Suggestions for improvement and further investigation are provided.

HeT-A, a transposable element specifically involved in "healing" broken chromosome ends in Drosophila melanogaster.

Eight terminally deleted Drosophila melanogaster chromosomes have now been found to be "healed." In each case, the healed chromosome end had acquired sequence from the HeT DNA family, a complex family of repeated sequences found only in telomeric and pericentric heterochromatin. The sequences were apparently added by transposition events involving no sequence homology. We now report that the sequences transposed in healing these chromosomes identify a novel transposable element, HeT-A, which makes up a subset of the HeT DNA family. Addition of HeT-A elements to broken chromosome ends appears to be polar. The proximal junction between each element and the broken chromosome end is an oligo(A) tract beginning 54 nucleotides downstream from a conserved AATAAA sequence on the strand running 5' to 3' from the chromosome end. The distal (telomeric) ends of HeT-A elements are variably truncated; however, we have not yet been able to determine the extreme distal sequence of a complete element. Our analysis covers approximately 2,600 nucleotides of the HeT-A element, beginning with the oligo(A) tract at one end. Sequence homology is strong (greater than 75% between all elements studied). Sequence may be conserved for DNA structure rather than for protein coding; even the most recently transposed HeT-A elements lack significant open reading frames in the region studied. Instead, the elements exhibit conserved short-range sequence repeats and periodic long-range variation in base composition. These conserved features suggest that HeT-A elements, although transposable elements, may have a structural role in telomere organization or maintenance.

Crude fiber determination using ceramic fiber to replace asbestos.

Crude fiber was determined in a wide range of feed products by a method which specifies ceramic fiber as a filter medium instead of the more hazardous and difficult to obtain asbestos. Results correlated well with those obtained by using AOAC official final action method 7.061-7.065 (correlation coefficient, 0.9994). For 8 samples, the coefficients of variation ranged from 0.74 to 4.80%. Compared with the AOAC method the proposed method showed a slight negative bias of 0.1%. Compared with asbestos, ceramic fiber was easier to prepare for use, filtering was faster, and samples bumped less.